Waltz Health, a digital health company focused on prescription drugs, launched Waltz Connect on Monday. The new solution aims to reduce the cost of specialty medications.
Chicago-based Waltz Health was founded in 2021 and serves payers and pharmacies. It has a product called Marketplace Search, which allows users to search for any prescription and see the range of prices available at their pharmacy. It also works with health plans to bring its marketplace solutions into their pharmacy benefit.
The company’s Waltz Connect product supports payers and focuses on specialty medications. When a specialty prescription is submitted for a member, Waltz Connect redirects it to the most suitable pharmacy, regardless of the pharmacy’s network status with the payer. This routing is based on the member’s benefit design and several factors, including price, turnaround time, fulfillment accuracy, member experience and adherence rates. These factors can be customized by drug class or specific drugs. Health plans also receive information on the member’s condition, prescription onboarding, the selected pharmacy’s contact information, expected fulfillment turnaround time and the number of refills.
In addition, Waltz Connect has a marketplace with a network of specialty pharmacies that compete on price, service levels and clinical outcomes, said Mark Thierer, Waltz Health co-founder and CEO. Waltz Health also announced Monday that specialty pharmacy Reliance Rx is joining the specialty pharmacy network.
“Part of what I think is the biggest value driver is that Waltz Connect provides payers with something they’ve been screaming for, which is unmatched transparency and it unlocks competition with these specialty pharmacies,” Thierer said in an interview.
Payers using Waltz Connect pay Waltz Health a fixed fee, Thierer added.
“We have no spread. We trap no rebates. We take no margin out of the pharmacy itself,” he stated. “So this is an entirely transparent model where we’re getting paid per prescription to deploy these services.”
The launch of Waltz Connect comes at a time when the cost of specialty drugs is growing, reaching more than $300 billion in 2021, a 43% increase since 2016, according to the U.S. Department of Health and Human Services. In 2021, specialty drugs accounted for 50% of total drug spending. Payers are struggling because they’re often overpaying for claims that have cheaper alternatives. Meanwhile, patients often battle delays in accessing life-saving medications. Specialty pharmacies are also struggling because they frequently receive prescriptions they can’t fill, according to Thierer.
Waltz Health launched Waltz Connect with these challenges in mind.
“It’s an ecosystem with not a lot of happy campers, and that is what we’re introducing today with Waltz Connect,” Thierer said.
Thierer has extensive experience in the pharmacy benefit management (PBM) space and previously served as CEO of OptumRx, which is one of the big three PBMs along with CVS Caremark and Express Scripts. He noted, however, that the traditional PBM model needs improvement when it comes to price transparency and the patient experience. In the long run, he hopes Waltz Health can be a “fully technology-enabled pharmacy benefit manager” that can be a substitute for these large players.
“The system is built with friction that’s substantial,” Thierer said. “Everything from prior authorizations to various approvals to formulary noncompliance and just actually not allowing you to get the medication that your doctors prescribed. … I think in the short term, it’ll be more likely that we’ll be working alongside [the big PBMs]. Over time, I do think we will be an alternative. It’ll be a new model, and we won’t likely be the only one.”
Photo: cagkansayin, Getty Images
